facebook
spears_logo

Top Recommended
Click to explore ranking

tatler_logo

Featured in
The Tatler Address Book

doctify_logo

Outstanding
Click to see reviews

spears_logo
tatler_logo
doctify_logo

What is posterior capsule opacification (PCO)?

3 min read

Posterior capsule opacification (PCO) is a clouding of the posterior lens capsule that occurs after cataract surgery. It is the most common long-term complication of cataract surgery, affecting an estimated 20% to 50% of patients within five years of their original procedure, though rates vary depending on intraocular lens design, surgical technique, and patient factors. ¹ ³

During cataract surgery, the cloudy natural lens is removed, but the posterior lens capsule, the thin, transparent membrane that originally held the lens, is intentionally left in place to support the implanted artificial intraocular lens (IOL). In the months to years following surgery, residual lens epithelial cells (LECs) that remain on the anterior capsule can proliferate, migrate across the posterior capsule, and undergo transformation processes including epithelial-mesenchymal transition (EMT) and fibrosis. ¹ This cellular activity results in opacification of the posterior capsule, obstructing the optical pathway between the IOL and the retina.

PCO manifests clinically in two principal forms: fibrotic PCO, characterised by wrinkling and contraction of the capsule, and regeneratory PCO, which presents as pearl-like Elschnig pearls formed from swollen lens epithelial cells. ² Patients experience symptoms similar to the original cataract: blurred or hazy vision, increased glare and halos around lights, reduced contrast sensitivity, and difficulty reading or performing tasks requiring fine visual discrimination.

The pathophysiology of PCO is driven by inflammatory mediators, growth factors released during surgery, and interactions between residual lens epithelial cells and the intraocular lens material and design. ¹ Modern hydrophobic acrylic IOLs with sharp posterior edges significantly reduce PCO rates compared to older lens designs. ³

References

  1. Awasthi N, Guo S, Wagner BJ. Posterior capsular opacification: Pathogenesis, challenges, and preventive strategies. Biomedicine and Pharmacotherapy. 2025;182:117720.
  2. Wormstone IM, Wang L, Liu CS. Posterior capsule opacification. Experimental Eye Research. 2009;88(2):257-269.
  3. Raj SM, Vasavada AR, Johar SR, Vasavada VA, Vasavada VA. Post-operative capsular opacification: a review. International Journal of Biomedical Science. 2007;3(4):237-250.

Related Topics

Return to Knowledge Base

About Blue Fin Vision®

Blue Fin Vision® is a GMC-registered, consultant-led ophthalmology clinic with CQC-regulated facilities across London, Hertfordshire, and Essex. Patient outcomes are independently audited by the National Ophthalmology Database, confirming exceptionally low complication rates.